This proposed four-year study will examine the adaptation process of elderly persons diagnosed with Primary Neuronal Degeneration - Alzheimer's type (PND-A). Person-environment congruence will serve as the theoretical framework. It is hypothesized that, as cognitive and physical health deteriorates, elderly with PND-A will experience greater incongruence and stress. The coping skills necessary to resolve this incongruence are also expected to deteriorate in advanced dementia. Fifty elderly persons diagnosed with Alzheimer's dementia, and who are in the early stages of the disease, will be followed longitudinally for three years. The healthy elderly spouse or family member of these patients will be asked other questions about the patient. Another sample of 50 healthy elderly not associated with PND-A patients will serve as matched controls. All respondents will be residing in their own homes at the start of the study. Participants' cognitive and physical health status, psychosocial status and needs will be measured every six months during the course of the study. Physiologic correlates of stress will also be assessed at these times, by measuring urine cortisol and catecholamine secretion of the 50 PND-A patients and their matched controls. Their physical and social environments will be evaluated at the same time to determine P-E congruence. The study is expected to contribute significantly to theory development in person-environment congruence, coping, stress and adaptation in dementia. Applied outcomes will include recommendations for the management and enhancement of well-being among older persons with dementia and their families.